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Pennsylvania rates for HCPCS 25628

Open Tx Carpal Scaphoid Navicular Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,068.00 / $8,247.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,393.00 / $11,479.00 / $18,724.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.94 / $823.94 / $823.94
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$81.69 / $81.69 / $81.69
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,753.02 / $13,084.27 / $24,092.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,102.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.94 / $823.94 / $823.94
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$81.69 / $81.69 / $81.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.05 / $707.04 / $707.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00